William J. Schulte

Resolution of postoperative ileus in humans

Bipolar electrodes were placed in the ascending and descending colon of 13 patients during laparotomy. The magnitude of their operations varied from exploratory laparotomy to total gastrectomy. The magnitude and length of the operations performed did not correlate positively with the duration of postoperative ileus. Signals were recorded for up to 4 hours daily for up to 8 days after operation during periods of rest and, in some patients, after administration of epidural or parenteral morphine sulfate. Power spectrum analyses of electrical control activity (ECA) showed dominant frequencies in both lower (2–9 cpm) and higher (9–14 cpm) ranges. During postoperative recovery, the mean ECA frequencies in right and left colon were relatively constant, but a variety of dominant ECA frequency relationships were observed. The modal pattern in the right colon was a shift in the dominant frequency from the higher to the lower range as recovery progressed, while the modal pattern in the left colon was persistent dominance of ECA in the higher frequency range. Electrical response activity (ERA) initially was comprised of only random, disorganized single bursts but became progressively more complex through the initial 3 postoperative days with the appearance of more organized bursts and clusters, some of which propagated very slowly (about 5 cm/min) both orad and aborad. ERA recovery culminated, typically on the third or fourth postoperative day, with the return of long bursts of continuous ERA, some of which propagated at a higher velocity (about 80 cm/ min) and exclusively in the aborad direction and which were accompanied by passage of flatus or by defecation.

Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study.

Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation. We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics. Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications. The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing. The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant.

Risk of recurrence of colon polyps.

At Wood Veterans Administration Center, 268 patients who had a polypectomy have been followed up to 20 years with semiannual proctosigmoidoscopic and barium enema examinations. For the present review of benign polyp disease, patients having coexisting carcinoma, chronic inflammatory disease, and those lost to followup have been excluded; 154 patients followed for a mean of 7 years comprise the study group. Thirty per cent of patients developed recurrent polyps. The risk of recurrence during the first year was 16 times that expected in a population of similar age and sex, but thereafter diminished steadily. After 48 months risk of polyp recurrence was little higher than the incidence expected in a normal population. Neither patient age, presenting symptoms nor the site or size of the initial polyp(s) were of any prognostic value regarding recurrence. Patients presenting with a villous adenoma or with more than 3 polyps had a significantly increased risk of recurrence may persist indefinitely. The overall incidence of colonic carcinoma may have been increased, but the location of subsequent cancer was not related to the site of a previously excised polyp.

A quarter Wheatstone bridge strain gage force transducer for recording gut motility.

Quarter and half Wheatstone bridge extraluminal force transducers for recording of gastrointestinal motility are compared. Modification of the transducer to a quarter bridge is economical, simplifies construction, and improves longevity by eliminating the crossover wire which frequently short circuits. The quarter bridge transducer was found to be as accurate and sensitive as the half bridge transducer.

Electromotor feeding responses of primate ileum and colon

Serosal bipolar electrodes to record spike discharges and strain gauge force transducers to record circular muscle contractions were placed in pairs on the terminal ileum, cecum, right colon at the ileocecal valve, ascending colon, and proximal transverse colon of sixteen primates. After an overnight fast, electromotor responses to continued fasting or to ingestion of a meal (randomized order) were recorded in awake animals. Feeding led to increased spike discharges and increased frequency of muscle contractions at all sites. The onset of these responses usually was within 6 minutes after feeding; the responses increased progressively during 30 to 45 minutes and then remained more or less at a constant plateau of increased activity. Atropine completely blocked the postcibal responses of ileum and proximal colon for up to 30 minutes. Transit time data of labeled meals excluded direct stimulation by a food bolus as the mechanism of the observed postcibal colonic response. The pattern of response was consistent with humoral mediation.

Glucagon, gastric inhibitory polypeptide and the gastrocolic response

Serosal bipolar electrodes and strain gauge force transducers were placed on the right and left colon in subhuman primates to record spike discharges and circular muscular contractions. The effect of glucagon on colonic motor and electrical activity were studied before and after meals. Serum concentration of gastric inhibitory polypeptide was measured simultaneously 15 minutes before and 45 minutes after eating. Serum levels of gastric inhibitory polypeptide increased in response to eating; pre- and postcibal concentrations were not altered by glucagon. The gastrocolic response of the colon to eating was demonstrated. Glucagon inhibited the intrinsic activity of the entire colon before meals and partly inhibited the right colon after meals. Postcibal left colon activity was not inhibited by glucagon. This indicates that a distinct mechanism accounts for the left colonic postcibal increase in contractile and electrical spike activity. A neural or humoral mechanism is implicated but is not specifically identified.

The gastrocolic response: Is it gip?

Abstract Previous experiments demonstrated that feeding is followed by increased electrical spike discharges and contractions of colon smooth muscle. This gastrocolic response has a definite lag period before onset, and is not due to distention of the colon by food. In these experiments, the possible association between altered serum concentration of certain gastrointestinal hormones and the gastrocolic response was investigated in eight stump-tailed monkeys. The animals had extraluminal miniature strain gauge force transducers and bipolar silver electrodes applied in pairs to the serosal surface of the cecum, ascending colon, and transverse colon to record contractions of circular muscle and electrical spike discharge potentials. The serum concentrations of gastrin, cholecystokinin, and gastric inhibitory polypeptide were measured by radioimmunoassay, and the contractile responses of the bowel were recorded, before and after presentation to fasted animals in random order of a dry meal, a wet saline meal, a wet magnesium sulfate meal, or a continued fast. The dry meal was associated with an increase in frequency of electrical spike discharges and contractions of circular colon muscle, as well as an increase in the serum concentration of gastric inhibitory polypeptide, both events occurring 15–60 min after beginning the meal. Other meals had no effect on colon motility or serum gastric inhibitory polypeptide concentration. Serum gastrin and cholecystokinin concentrations were unchanged by all experimental manipulations. This evidence supports our hypothesis that the gastrocolic response has an hormonal basis.

Ulcerogenic tumor of the duodenum

Abstract Three patients with “islet cell-carcinoid” tumors of the duodenum are reviewed. In each of these cases the presence of lymph node metastasis eventually prompted total gastrectomy as the course of treatment. The patient in case I is now clinically free of tumor five years after operation. In case II the patients death occurred two years after surgery, and although tumor was found at operation, it was not related to his death. In case III the patient is alive and well five years after his surgical procedures.

Effect of total gastrectomy on growth in puppies

Abstract 1. 1. Eight puppies had total gastrectomy and three are living and well fifteen months after operation. 2. 2. Total gastrectomy is feasible in puppies and compatible with adequate if not normal growth. 3. 3. Hypochromic anemia does occur and is associated with a general debility in the animals but responds to parenteral iron therapy. 4. 4. Pernicious anemia has not developed in any of the animals. 5. 5. In all animals with total gastrectomy osteomalacia has developed with resulting pathologic fractures from the animals which recovered spontaneously.

Selective versus truncal vagotomy. A comprehensive study of fecal nitrogen and fat losses.

Abstract A comparison has been made of the changes in body weight, stool bulk, and fecal fat and nitrogen excretion after both selective and truncal vagal denervation in the same animal in an effort to study differences between these two procedures. The following results were obtained. 1. 1. After pyloroplasty alone or pyloroplasty accompanied by vagotomy, either truncal, selective, or “reverse selective,” that is, sectioning only the hepatic and celiac trunks, body weight decreased. This weight was not regained totally in any animal over a two to seven month period of observation but neither were there any further significant losses despite further surgery. 2. 2. Stool bulk increased after truncal vagotomy and did not differ significantly after selective division. 3. 3. Fecal fat excretion (a) increased after pyloroplasty alone; (b) increased after pyloroplasty accompanied by selective vagotomy; (c) increased after pyloroplasty accompanied by truncal vagotomy. 4. 4. Fecal nitrogen excretion (a) did not increase after pyloroplasty alone; (b) did not increase after pyloroplasty accompanied by selective vagotomy; (c) increased after pyloroplasty accompanied by truncal vagotomy. 5. 5. The presence of greater stool bulk after truncal vagotomy did not coincide with a decrease in body weight in the animals in which it occurred. The excretion of fecal fat is greater after selective vagotomy than after truncal vagotomy when both are performed in the same animal, but nitrogen excretion is greater after truncal division. From this data, we have concluded that selective vagotomy has no great advantages over truncal division, and the extra time and care necessary to perform selective denervation are not warranted.